Abstract：
OBJECTIVE: To assess the management and outcomes of afebrile infants who received a pediatric dermatology consultation for pustules and/or vesicles.
METHODS: Medical records were reviewed for all infants 60 days of age or younger who received a pediatric dermatology consult across 6 academic institutions between September 1, 2013 and August 31, 2019 to identify those infants with pustules and/or vesicles.
RESULTS: Of the 879 consults, 183 afebrile infants presented with pustules and/or vesicles. No cerebrospinal fluid cultures or blood cultures were positive for bacteria. No concordant positive urine cultures were identified in infants with cutaneous infection. Nine infants were diagnosed with herpes simplex virus (HSV). Five preterm infants were diagnosed with angioinvasive fungal infections.
CONCLUSIONS: No serious bacterial infections attributable to a skin source were identified, yet 53% of these infants received parenteral antibiotics. HSV was diagnosed in 7% of this cohort, 77.8% (7/9) of whom were term infants and 22.2% (2 of 9) of whom were preterm. Angioinvasive fungal infection was diagnosed in 3%, all of whom (100%, 5 of 5) were extremely preterm at <28 weeks gestational age. These findings suggest that in full-term afebrile infants ≤60 days, the likelihood of a life-threatening etiology of isolated pustules or vesicles is low once HSV infection is excluded. In preterm infants with pustules and/or vesicles, a high index of suspicion must be maintained, and broad infectious evaluation is recommended. HSV testing is recommended for all infants with vesicles, grouped pustules and/or punched-out erosions.
METHODS: Medical records were reviewed for all infants 60 days of age or younger who received a pediatric dermatology consult across 6 academic institutions between September 1, 2013 and August 31, 2019 to identify those infants with pustules and/or vesicles.
RESULTS: Of the 879 consults, 183 afebrile infants presented with pustules and/or vesicles. No cerebrospinal fluid cultures or blood cultures were positive for bacteria. No concordant positive urine cultures were identified in infants with cutaneous infection. Nine infants were diagnosed with herpes simplex virus (HSV). Five preterm infants were diagnosed with angioinvasive fungal infections.
CONCLUSIONS: No serious bacterial infections attributable to a skin source were identified, yet 53% of these infants received parenteral antibiotics. HSV was diagnosed in 7% of this cohort, 77.8% (7/9) of whom were term infants and 22.2% (2 of 9) of whom were preterm. Angioinvasive fungal infection was diagnosed in 3%, all of whom (100%, 5 of 5) were extremely preterm at <28 weeks gestational age. These findings suggest that in full-term afebrile infants ≤60 days, the likelihood of a life-threatening etiology of isolated pustules or vesicles is low once HSV infection is excluded. In preterm infants with pustules and/or vesicles, a high index of suspicion must be maintained, and broad infectious evaluation is recommended. HSV testing is recommended for all infants with vesicles, grouped pustules and/or punched-out erosions.
摘要：
■评估接受儿科皮肤科脓疱和/或囊泡咨询的无热婴儿的管理和结果。
在2013年9月1日至2019年8月31日期间，在6个学术机构接受儿科皮肤病学咨询的所有60天及以下婴儿的病历进行了审查，以确定那些患有脓疱和/或囊泡的婴儿。
■在879个咨询中，183例发热婴儿出现脓疱和/或囊泡。脑脊液培养或血液培养均未见细菌阳性。在皮肤感染的婴儿中未发现一致的尿液培养阳性。9名婴儿被诊断为单纯疱疹病毒（HSV）。五名早产儿被诊断为血管侵袭性真菌感染。
■未发现由皮肤来源引起的严重细菌感染，然而,53%的婴儿接受了肠胃外抗生素治疗.该队列中有7%被诊断为HSV，77.8％（7/9）是足月婴儿，22.2％（9个中的2个）是早产。3％诊断为血管侵袭性真菌感染，所有人(100%，5个中的5个）在<28周胎龄时极度早产。这些发现表明，足月无发热婴儿≤60天，一旦HSV感染被排除,孤立的脓疱或囊泡出现危及生命的病因的可能性很低.在有脓疱和/或囊泡的早产儿中，必须保持高度怀疑，建议进行广泛的感染性评估。建议对所有有囊泡的婴儿进行HSV测试，成组的脓疱和/或穿孔性糜烂。
在2013年9月1日至2019年8月31日期间，在6个学术机构接受儿科皮肤病学咨询的所有60天及以下婴儿的病历进行了审查，以确定那些患有脓疱和/或囊泡的婴儿。
■在879个咨询中，183例发热婴儿出现脓疱和/或囊泡。脑脊液培养或血液培养均未见细菌阳性。在皮肤感染的婴儿中未发现一致的尿液培养阳性。9名婴儿被诊断为单纯疱疹病毒（HSV）。五名早产儿被诊断为血管侵袭性真菌感染。
■未发现由皮肤来源引起的严重细菌感染，然而,53%的婴儿接受了肠胃外抗生素治疗.该队列中有7%被诊断为HSV，77.8％（7/9）是足月婴儿，22.2％（9个中的2个）是早产。3％诊断为血管侵袭性真菌感染，所有人(100%，5个中的5个）在<28周胎龄时极度早产。这些发现表明，足月无发热婴儿≤60天，一旦HSV感染被排除,孤立的脓疱或囊泡出现危及生命的病因的可能性很低.在有脓疱和/或囊泡的早产儿中，必须保持高度怀疑，建议进行广泛的感染性评估。建议对所有有囊泡的婴儿进行HSV测试，成组的脓疱和/或穿孔性糜烂。
